海南医科大学学报

目的:系统评价中医药改善类风湿关节炎(rheumatoid arthritis,RA)骨破坏的疗效,为临床治疗提供指导。方法:计算机检索中国知网数据库(CNKI)、中国生物医学文献检索(SinoMed)、万方数据知识服务系统(WanFang Data)、维普全文数据库(VIP)、PubMed、MedLine、cochrane library,搜集有关中医药治疗类风湿关节炎骨破坏的随机对照试验(RCT),由2位研究人员筛查从建库至2020年2月的文献,提取所需指标,并纳入RevMan 5.2分析。结果:纳入14例RCT,共计1 291例患者。Meta分析结果显示,治疗组与对照组相比较:(1)中医药治疗组能够改善RA骨破坏患者的25-羟基维生素-D,且优于西药对照组,差异有统计学意义(P<0.05);(2)中医药治疗组能够改善RA骨破坏患者的成骨细胞与破骨细胞的平衡(细胞核因子κB受体活化因子配;骨密度;骨碱性磷酸酶;骨保护素;骨钙素),且优于西药对照组,差异有统计学意义(P<0.05);(3)中医药治疗组能够改善RA骨破坏患者的成骨细胞与破骨细胞的平衡(Ⅰ型前胶原氨基端前肽;胶原羧基末端肽;细胞核因子κB受体活化因子配/骨保护素),疗效与西药对照组相当,差异无统计学意义(P>0.05)。结论:目前现有证据可以证明中医药在治疗类风湿关节炎骨破坏具有确切疗效,调节成骨细胞与破骨细胞功能,改善患者的骨代谢水平,阻止骨破坏的进展。

Objective:To systematically evaluate the efficacy of traditional Chinese medicine for improving bone damage in rheumatoid arthritis(RA),and provide guidance for clinical treatment. Methods:Computer retrieval China hownet database(CNKI),Chinese biomedical literature retrieval(SinoMed),ten thousand Data knowledge service system(WanFang Data),VIP full-text database(VIP),PubMed,MedLine and the cochrane library,were used to collect relevant Chinese medicine for the treatment of rheumatoid arthritis,bone destruction randomized controlled trial(RCT),with 2 researchers screening out the literature from the building of the two libraries to February 2020,to extract the required indicators,and incorporated into RevMan 5.2 analysis.Results:A total of 1 291 patients in 14 RCTS were included. The results of meta-analysis showed that compared with the control group,the traditional Chinese medicine treatment group could improve the 25-hydroxyvitamin D of patients with RA bone damage,which was better than the western medicine control group,and the difference was statistically significant. tradifiond Chinese medicine group treatment group can improve the balance between osteoblasts and osteoclasts(nuclear factor B receptor activating factor;bone mineral density;bone alkaline phosphatase;bone protectin;(osteocalcin),and was superior to the western medicine control group,the difference was statistically significant.Moreover,traditional Chinese medicine treatment group can improve RA patients with bone destruction of the balance of osteoblast and osteoclast（Ⅰtype collagen amino terminal propeptide before;Carboxy-terminal peptide of collagen;The effect of nuclear factor B receptor activator factor and bone protectin was similar to that of the western medicine control group,and the difference was not statistically significant.Conclusion:At present,the existing evidence can prove that traditional Chinese Medicine in the treatment of rheumatoid arthritis bone damage has an exact effect,regulate the function of osteoblasts and osteoclasts,improve the level of bone metabolism of patients,prevent the progress of bone damage.